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Quality Analyst-Medicare Call Center

Job Summary:

Responsible for reviewing recordings of calls with Medicare members to determine if the call was handled in compliance with Medicare requirements and Plan customer service standards

Essential Functions:

  • Provide subject matter expertise in Medicare call requirements
  • Provide review, interpretation and implementation of state and federal guidance
  • Score calls in accordance with quality scorecard
  • Identify trends with call failures
  • Mentor and provide feedback on calls
  • Oversee and administer ongoing monitoring program(s) based on CMS guidance
  • Updates policies, procedures and project work plans as needed.
  • Adhere to established corporate policies and procedures
  • Perform other duties, as necessary, to meet corporate objectives
  • Travel as required

Qualifications:

  • A minimum of five (5) years experience in a Medicare Advantage call center
  • Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint: Required
  • Experience with Medicare and/or Medicaid regulations and guidance: Required
  • Advanced degree or certification in audit, pharmacy or compliance discipline: Preferred
  • Prior project management training and/or experience: Preferred
  • Must have strong verbal and written communication skills.
  • Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
  • Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.

 


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Quality Analyst-Medicare Call Center

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